Provider Demographics
NPI:1538330931
Name:WEST END PODIATRY PC
Entity Type:Organization
Organization Name:WEST END PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:URIEL
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-812-4204
Mailing Address - Street 1:2044 OCEAN AVE
Mailing Address - Street 2:SUITE B1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7328
Mailing Address - Country:US
Mailing Address - Phone:718-812-4204
Mailing Address - Fax:
Practice Address - Street 1:2044 OCEAN AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7328
Practice Address - Country:US
Practice Address - Phone:718-812-4204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004931213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07978Medicare PIN